2027 UNL Poland Pilgrimage Registration

2027 Poland Pilgrimage Registration

UNL Newman Center
Pilgrimage
Who is registering for the pilgrimage and how would you like to be billed?
Participant's Name

First NameLast Name
Participant's Full Legal Name (as it appears on your passport or government ID)

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant's Email Address
example@example.com
Participant's Cellphone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Residential Address
Participant's Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Passport Validity

Please note: If your passport expires before June 20, 2027, US Customs & Border Protection considers it expired and invalid for our travel dates. If your passport expires before June 20, 2027, you must apply for and receive a new passport before our departure.
Does the participant currently have a valid passport for our travel dates?
Passport Number
Global Entry Number (if applicable)
TSA PreCheck Number (if applicable)
Acknowledgment of Physical Requirements

I understand and accept that this pilgrimage requires the ability to walk up to 7 miles per day at a pace of approximately 20 minutes per mile, stand for extended periods of time, and climb stairs with relative ease. If I am unable to meet these physical requirements, I understand that I may be unable to participate in certain scheduled activities and may need to arrange and pay for additional transportation, such as taxis, at my own expense.
Name of Preferred Roommate(s)

Health & Dietary Information
Participant's Health Concerns (if none, write "none")
Health Insurance Carrier (if none, write "none")
Health Insurance Group Number (if none, write "none")
Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Emergency Contact's Relationship to Participant
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Flight Arrangements
Airfare Payment Agreement

I hereby acknowledge that I understand the advertised cost of the trip does not include the cost of airfare. I further acknowledge and accept that Lolek Corp. will communicate the additional airfare cost only after the registration period has closed and group airfare arrangements have been secured.

Upon notification of the finalized airfare cost by Lolek Corp., I will have a period of 12 hours to notify Lolek Corp. in writing if I choose to withdraw from the trip. I understand that if I elect to withdraw, I will be subject to Lolek Corp.'s stated refund policy.

Should I fail to notify Lolek Corp. of my intent to withdraw within the 12 hour period, I understand and agree that my airline ticket will be automatically issued, and I accept full responsibility for payment of the full ticket price to Lolek Corp. within the designated payment timeframe provided.

I also understand that any potential refunds for cancellation of the airline ticket after the 12 hour deadline will be subject to the terms and conditions of the airline’s refund policy, and not at the discretion of Lolek Corp.

By typing my name below, I hereby affirm that I have read, understood, and consent to the terms outlined in this Airfare Payment Agreement.

By signing below, I confirm that I have read and agree to the above terms.
Participant's Electronic Signature for Airfare Payment Agreement (See Above)

Media Release
Lolek Pilgrimage Media Release

I acknowledge that photographs, video recordings, written excerpts, and/or voice recordings of trip participants may be captured during the course of the pilgrimage for use in promotional, educational, or informational materials, including but not limited to illustrations, publications, social media, and websites.

I hereby grant full and unrestricted permission to Lolek Corp., its representatives, employees, agents, successors, licensees, and assigns, to record, use, reproduce, publish, distribute, and copyright any such photographs, videos, written materials, or voice recordings in which I may appear or be heard, without limitation or compensation, while enrolled as a participant in the pilgrimage.

This authorization includes the use of my likeness and/or voice for any lawful purpose related to the activities and mission of Lolek Corp., in perpetuity and in any medium now known or later developed.

By typing my name below, I affirm that I have read, understood, and voluntarily consent to the terms of this Media Release.
Participant's Signature for Media Release (See Above)

Privacy Policy
By submitting this form, I consent to the collection, use, and storage of the personal information provided in this registration (including sensitive information such as passport details) as described in Lolek Corp’s Privacy Policy for the purpose of processing the pilgrimage registration.

If registering a minor under 18, I confirm that I am the parent or legal guardian and give consent on their behalf.
Consent to Privacy Policy
Notes 2
Should be Empty:

2027 Poland Pilgrimage Registration

Billing Information

Health & Dietary Information

Emergency Contact Information

Flight Arrangements

Media Release

Privacy Policy